Alberto Esteban-Fernández ^1* Alejandro Recio-Mayoral ² Raquel López-Vilella ³ Gregorio de Lara ⁴ Moisés Barrantes-Castillo ⁵ Inés Gómez-Otero ⁶ Julio Nunez ⁷ Carolina Robles-Gamboa ⁸ José López-Aguilera ⁹ Ángel Iniesta-Manjavacas ¹⁰ Paula Fluvià ¹¹ Francisco Pastor-Pérez ¹² Laia Tornero-Belarte ¹³ Gonzalo Alonso Salinas ¹⁴ Pablo Diez-Villanueva ¹⁵

• ¹ Hospital Universitario Severo Ochoa, Madrid, Spain
• ² Virgen del Rocío University Hospital, Seville, Spain
• ³ La Fe Hospital, Valencia, Valencia, Spain
• ⁴ Torrevieja General University Hospital, Torrevieja, Spain
• ⁵ Hospital de Palamós, Palamos, Spain
• ⁶ University Clinical Hospital of Santiago, Santiago de Compostela, Galicia, Spain
• ⁷ Hospital Clínico Universitario de Valencia, Valencia, Valencia, Spain
• ⁸ Toledo University Hospital, Toledo, Spain
• ⁹ Hospital Reina Sofía de Córdoba, Cordova, Spain
• ¹⁰ University Hospital La Paz, La Paz, Madrid, Spain
• ¹¹ Doctor Josep Trueta Girona University Hospital, Girona, Catalonia, Spain
• ¹² Virgen de la Arrixaca University Hospital, Murcia, Murcia, Spain
• ¹³ Hospital del Mar, Parc de Salut Mar, Barcelona, Catalonia, Spain
• ¹⁴ Complejo Hospitalario de Navarra, Pamplona, Navarre, Spain
• ¹⁵ Princess University Hospital, Madrid, Madrid, Spain

Introduction. Vericiguat, an oral stimulator of soluble guanylate cyclase, reduces cardiovascular mortality and hospitalisations in patients with heart failure (HF) and reduced ejection fraction, as demonstrated in the VICTORIA trial. This study assessed the real-world use of vericiguat. Material and methods. This cross-sectional, prospective and multicenter registry (VERISEC) included 776 patients from 43 centres in Spain between December 2022 and October 2023. Of these patients, 79.6% were male, with a mean age of 72.4 (SD:8.7) years. Patients in VERISEC were older and had more comorbidities (diabetes, advanced chronic kidney disease) compared to VICTORIA, with 20% having an estimated glomerular filtration rate below 30 mL/min. They also had higher natriuretic peptide levels [NT-proBNP: 3551 (IQR: 1675.9,7054.0)] pg/mL. Most patients (79.8%) started vericiguat after HF decompensation within the previous three months, with high use of loop diuretics (with an average dose of 65 mg/day) and implanted devices (50%). Sixty percent of patients were on quadruple therapy, with a higher use of sodium-glucose co-transporter 2 inhibitors compared to the VICTORIA trial. Despite the more severe disease in the VERISEC cohort, the implementation of guideline-directed medical therapy was greater than in VICTORIA, although vericiguat was initiated at lower blood pressure levels. Conclusions. Patients in the VERISEC registry had more severe illness and higher comorbidities compared to those in the VICTORIA, despite receiving optimised treatments. Further research is needed to identify which patients may benefit the most from vericiguat treatment.